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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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Safety Performance History Records Request - Snap-Out Format, Carbon Copy, 8-1/2" W x 11-3/4" L

Features 3-ply forms (8-1/2" x 11-3/4") with carbon copy.

Product Code:9620
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Effective January 6, 2023: Motor carriers will no longer need to contact a CDL driver’s former employers to inquire about FMCSA drug or alcohol testing violations. Motor carriers must run a Drug & Alcohol Clearinghouse query instead. Former employers must still be contacted for employment verification and the driver’s crash history. Therefore, drug/alcohol questions have been removed from the Safety Performance History Records Request form (No. 9620 or 9652). The revised Previous Employer Alcohol & Drug Test Information form (No. 6827 or 6828) should be used to obtain information about an applicant’s DOT drug or alcohol violations that occurred under a non-FMCSA agency (FAA, FTA, FRA, PHMSA, etc.).

  • Use to help satisfy 49 CFR §391.23(a)(2), (d), and (e), which require the prospective employer to obtain driver identification, employment and accident history from a driver/applicant's previous employers
  • Covers driver/applicant's authorization to release information; employment verification and accident information
  • Snap-out format
  • Three plies
  • Carbon copy
  • Measures 8-1/2" x 11-3/4"
  • Imprinting available. Call toll-free for pricing.

Number of Plies: 3

Compliance Topic: Injury & Illness Recordkeeping, DOT Drug & Alcohol Management

Size: 8.5" x 11.75"

Format: Snap-out

Need to Purchase a Case?: 1,000 per case

Industry: Human Resources, Transportation

Average Rating: 4.0

BVNumberOfReviews: 1

UNSPSC Number: Examination booklets or forms - 14111533

Advantage Savings: Advantage Savings

Country Of Origin: USA